中国内地高终末期肝病模型评分患者行半肝与全肝移植的结局：一项匹配分析。

Outcomes of hemi- versus whole liver transplantation in patients from mainland china with high model for end-stage liver disease scores: a matched analysis.

机构信息

Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.

出版信息

BMC Surg. 2020 Nov 20;20(1):290. doi: 10.1186/s12893-020-00965-8.

DOI:10.1186/s12893-020-00965-8

PMID:33218334

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7677100/

Abstract

BACKGROUND

Adult hemiliver transplantation (AHLT) is an important approach given the current shortage of donor livers. However, the suitability of AHLT versus adult whole liver transplantation (AWLT) for recipients with high Model for End-Stage Liver Disease (MELD) scores remains controversial.

METHODS

We divided patients undergoing AHLT and AWLT into subgroups according to their MELD scores (≥ 30: AHLT, n = 35; AWLT, n = 88; and < 30: AHLT, n = 323; AWLT, n = 323). Patients were matched by demographic data and perioperative conditions according to propensity scores. A cut-off value of 30 for MELD scores was determined by comparing the overall survival data of 735 cases of nontumor liver transplantation.

RESULTS

Among patients with an MELD score ≥ 30 and < 30, AHLT was found to be associated with increased warm ischemia time, operative time, hospitalization time, and intraoperative blood loss compared with AWLT (P < 0.05). In the MELD ≥ 30 group, although the 5-year survival rate was significantly higher for AWLT than for AHLT (P = 0.037), there was no significant difference between AWLT and AHLT in the MELD < 30 group (P = 0.832); however, we did not observe a significant increase in specific complications following AHLT among patients with a high MELD score (≥ 30). Among these patients, the incidence of complications classified as Clavien-Dindo grade III or above was significantly higher in patients undergoing AHLT than in those undergoing AWLT (25.7% vs. 11.4%, P = 0.047). For the MELD < 30 group, there was no significant difference in the incidence of complications classified as Clavien-Dindo grade III or above for patients undergoing AHLT or AWLT.

CONCLUSION

In patients with an MELD score < 30, AHLT can achieve rates of mortality and overall survival comparable to AWLT. In those with an MELD score ≥ 30, the prognosis and incidence of complications classified as Clavien-Dindo III or above are significantly worse for AHLT than for AWLT; therefore, we may need to be more cautious regarding the conclusion that patients with a high MELD score can safely undergo AHLT.

摘要

背景

成人半肝移植（AHLT）是解决供肝短缺的重要手段。然而，对于终末期肝病模型评分（MELD）较高的患者，AHLT 与成人全肝移植（AWLT）相比是否更适用仍存在争议。

方法

我们根据 MELD 评分将接受 AHLT 和 AWLT 的患者分为亚组（≥30：AHLT，n=35；AWLT，n=88；<30：AHLT，n=323；AWLT，n=323）。根据倾向评分，按人口统计学数据和围手术期情况对患者进行匹配。通过比较 735 例非肿瘤性肝移植的总生存率数据，确定 MELD 评分的截断值为 30。

结果

在 MELD 评分≥30 和<30 的患者中，与 AWLT 相比，AHLT 与热缺血时间、手术时间、住院时间和术中出血量增加有关（P<0.05）。在 MELD≥30 组中，尽管 AWLT 的 5 年生存率明显高于 AHLT（P=0.037），但在 MELD<30 组中，AWLT 和 AHLT 之间无显著差异（P=0.832）；然而，我们并未观察到在 MELD 评分较高（≥30）的患者中，AHLT 会导致特定并发症显著增加。在这些患者中，行 AHLT 的患者发生 Clavien-Dindo 分级 III 或以上并发症的发生率明显高于行 AWLT 的患者（25.7%比 11.4%，P=0.047）。对于 MELD<30 组，行 AHLT 或 AWLT 的患者发生 Clavien-Dindo 分级 III 或以上并发症的发生率无显著差异。

结论

对于 MELD 评分<30 的患者，AHLT 可达到与 AWLT 相当的死亡率和总体生存率。对于 MELD 评分≥30 的患者，AHLT 的预后和 Clavien-Dindo III 或以上并发症的发生率明显差于 AWLT；因此，对于 MELD 评分较高的患者可安全行 AHLT 的结论，我们可能需要更为谨慎。